Measurement and monitoring of nausea severity in emergency department patients: a comparison of scales and exploration of treatment efficacy outcome measures

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Abstract

OBJECTIVES: The objective was to investigate the correlation of the visual analog scale (VAS) and numeric rating scale (NRS) for nausea severity measurement and to explore options for improved reporting of antiemetic efficacy trial results. METHODS: This was a multicenter observational study of adult emergency department (ED) patients with nausea. Participants rated severity at enrollment and 30 minutes posttreatment using an adjectival scale, a VAS, and an NRS. Posttreatment, patients described symptom change and rated satisfaction. RESULTS: Ratings were performed by 258 patients. Both the VAS (0 to 100 mm) and the NRS (0 to 10) discriminated between adjectival severity categories. Median ratings with interquartile ranges (IQRs) were severe VAS 90.5 (IQR = 79 to 97) and NRS 9 (IQR = 8 to 9), moderate VAS 59 (IQR = 48 to 71) and NRS 6 (IQR = 5 to 7), mild VAS 34 (IQR = 25 to 49) and NRS 4 (IQR = 3 to 5), and none VAS 5 (IQR = 0 to 9) and NRS 0 (IQR = 0 to 1). Correlation between the VAS and NRS was high (0.83, Spearman). For the VAS, median mm (IQR) reductions for posttreatment change were a lot less -42 (IQR = -26 to -58.5), a little less -20.5 (IQR = -11 to -33), the same -2 (IQR = -8 to 3.5), a little more 14 (IQR = -2 to 22), and a lot more 17 (IQR = 6 to 23) and for satisfaction were very satisfied -45 (IQR = -27 to 63), satisfied -27 (IQR = -13 to 46), unsure -15 (IQR = -3 to -24), dissatisfied 4.5 (IQR = -5.5 to 13.5), and very dissatisfied 8.5 (IQR = 0 to 23). A VAS cutoff of >/=-5 mm detected symptom improvement with sensitivity 91.6 (95 CI = 86.7 to 95.1 ), specificity 72.1 (95 CI = 59.9 to 82.3 ), and positive predictive value 90.2 (95 CI = 85.1 to 94.0 ). CONCLUSIONS: The VAS and NRS correlate highly. A VAS cutoff level of >/=-5 mm was a good predictor of symptom improvement, suggesting that its inclusion as an outcome measure would enhance reporting in antiemetic efficacy trials.
Original languageEnglish
Pages (from-to)685 - 693
Number of pages9
JournalAcademic Emergency Medicine
Volume22
Issue number6
DOIs
Publication statusPublished - 2015

Cite this

@article{5c64161768cc4d149f4d619e9c70bf74,
title = "Measurement and monitoring of nausea severity in emergency department patients: a comparison of scales and exploration of treatment efficacy outcome measures",
abstract = "OBJECTIVES: The objective was to investigate the correlation of the visual analog scale (VAS) and numeric rating scale (NRS) for nausea severity measurement and to explore options for improved reporting of antiemetic efficacy trial results. METHODS: This was a multicenter observational study of adult emergency department (ED) patients with nausea. Participants rated severity at enrollment and 30 minutes posttreatment using an adjectival scale, a VAS, and an NRS. Posttreatment, patients described symptom change and rated satisfaction. RESULTS: Ratings were performed by 258 patients. Both the VAS (0 to 100 mm) and the NRS (0 to 10) discriminated between adjectival severity categories. Median ratings with interquartile ranges (IQRs) were severe VAS 90.5 (IQR = 79 to 97) and NRS 9 (IQR = 8 to 9), moderate VAS 59 (IQR = 48 to 71) and NRS 6 (IQR = 5 to 7), mild VAS 34 (IQR = 25 to 49) and NRS 4 (IQR = 3 to 5), and none VAS 5 (IQR = 0 to 9) and NRS 0 (IQR = 0 to 1). Correlation between the VAS and NRS was high (0.83, Spearman). For the VAS, median mm (IQR) reductions for posttreatment change were a lot less -42 (IQR = -26 to -58.5), a little less -20.5 (IQR = -11 to -33), the same -2 (IQR = -8 to 3.5), a little more 14 (IQR = -2 to 22), and a lot more 17 (IQR = 6 to 23) and for satisfaction were very satisfied -45 (IQR = -27 to 63), satisfied -27 (IQR = -13 to 46), unsure -15 (IQR = -3 to -24), dissatisfied 4.5 (IQR = -5.5 to 13.5), and very dissatisfied 8.5 (IQR = 0 to 23). A VAS cutoff of >/=-5 mm detected symptom improvement with sensitivity 91.6 (95 CI = 86.7 to 95.1 ), specificity 72.1 (95 CI = 59.9 to 82.3 ), and positive predictive value 90.2 (95 CI = 85.1 to 94.0 ). CONCLUSIONS: The VAS and NRS correlate highly. A VAS cutoff level of >/=-5 mm was a good predictor of symptom improvement, suggesting that its inclusion as an outcome measure would enhance reporting in antiemetic efficacy trials.",
author = "Robert Meek and Diana Egerton-Warburton and Michaela Mee and George Braitberg",
year = "2015",
doi = "10.1111/acem.12685",
language = "English",
volume = "22",
pages = "685 -- 693",
journal = "Academic Emergency Medicine",
issn = "1069-6563",
publisher = "Wiley-Blackwell",
number = "6",

}

TY - JOUR

T1 - Measurement and monitoring of nausea severity in emergency department patients: a comparison of scales and exploration of treatment efficacy outcome measures

AU - Meek, Robert

AU - Egerton-Warburton, Diana

AU - Mee, Michaela

AU - Braitberg, George

PY - 2015

Y1 - 2015

N2 - OBJECTIVES: The objective was to investigate the correlation of the visual analog scale (VAS) and numeric rating scale (NRS) for nausea severity measurement and to explore options for improved reporting of antiemetic efficacy trial results. METHODS: This was a multicenter observational study of adult emergency department (ED) patients with nausea. Participants rated severity at enrollment and 30 minutes posttreatment using an adjectival scale, a VAS, and an NRS. Posttreatment, patients described symptom change and rated satisfaction. RESULTS: Ratings were performed by 258 patients. Both the VAS (0 to 100 mm) and the NRS (0 to 10) discriminated between adjectival severity categories. Median ratings with interquartile ranges (IQRs) were severe VAS 90.5 (IQR = 79 to 97) and NRS 9 (IQR = 8 to 9), moderate VAS 59 (IQR = 48 to 71) and NRS 6 (IQR = 5 to 7), mild VAS 34 (IQR = 25 to 49) and NRS 4 (IQR = 3 to 5), and none VAS 5 (IQR = 0 to 9) and NRS 0 (IQR = 0 to 1). Correlation between the VAS and NRS was high (0.83, Spearman). For the VAS, median mm (IQR) reductions for posttreatment change were a lot less -42 (IQR = -26 to -58.5), a little less -20.5 (IQR = -11 to -33), the same -2 (IQR = -8 to 3.5), a little more 14 (IQR = -2 to 22), and a lot more 17 (IQR = 6 to 23) and for satisfaction were very satisfied -45 (IQR = -27 to 63), satisfied -27 (IQR = -13 to 46), unsure -15 (IQR = -3 to -24), dissatisfied 4.5 (IQR = -5.5 to 13.5), and very dissatisfied 8.5 (IQR = 0 to 23). A VAS cutoff of >/=-5 mm detected symptom improvement with sensitivity 91.6 (95 CI = 86.7 to 95.1 ), specificity 72.1 (95 CI = 59.9 to 82.3 ), and positive predictive value 90.2 (95 CI = 85.1 to 94.0 ). CONCLUSIONS: The VAS and NRS correlate highly. A VAS cutoff level of >/=-5 mm was a good predictor of symptom improvement, suggesting that its inclusion as an outcome measure would enhance reporting in antiemetic efficacy trials.

AB - OBJECTIVES: The objective was to investigate the correlation of the visual analog scale (VAS) and numeric rating scale (NRS) for nausea severity measurement and to explore options for improved reporting of antiemetic efficacy trial results. METHODS: This was a multicenter observational study of adult emergency department (ED) patients with nausea. Participants rated severity at enrollment and 30 minutes posttreatment using an adjectival scale, a VAS, and an NRS. Posttreatment, patients described symptom change and rated satisfaction. RESULTS: Ratings were performed by 258 patients. Both the VAS (0 to 100 mm) and the NRS (0 to 10) discriminated between adjectival severity categories. Median ratings with interquartile ranges (IQRs) were severe VAS 90.5 (IQR = 79 to 97) and NRS 9 (IQR = 8 to 9), moderate VAS 59 (IQR = 48 to 71) and NRS 6 (IQR = 5 to 7), mild VAS 34 (IQR = 25 to 49) and NRS 4 (IQR = 3 to 5), and none VAS 5 (IQR = 0 to 9) and NRS 0 (IQR = 0 to 1). Correlation between the VAS and NRS was high (0.83, Spearman). For the VAS, median mm (IQR) reductions for posttreatment change were a lot less -42 (IQR = -26 to -58.5), a little less -20.5 (IQR = -11 to -33), the same -2 (IQR = -8 to 3.5), a little more 14 (IQR = -2 to 22), and a lot more 17 (IQR = 6 to 23) and for satisfaction were very satisfied -45 (IQR = -27 to 63), satisfied -27 (IQR = -13 to 46), unsure -15 (IQR = -3 to -24), dissatisfied 4.5 (IQR = -5.5 to 13.5), and very dissatisfied 8.5 (IQR = 0 to 23). A VAS cutoff of >/=-5 mm detected symptom improvement with sensitivity 91.6 (95 CI = 86.7 to 95.1 ), specificity 72.1 (95 CI = 59.9 to 82.3 ), and positive predictive value 90.2 (95 CI = 85.1 to 94.0 ). CONCLUSIONS: The VAS and NRS correlate highly. A VAS cutoff level of >/=-5 mm was a good predictor of symptom improvement, suggesting that its inclusion as an outcome measure would enhance reporting in antiemetic efficacy trials.

UR - http://onlinelibrary.wiley.com/doi/10.1111/acem.12685/epdf

U2 - 10.1111/acem.12685

DO - 10.1111/acem.12685

M3 - Article

VL - 22

SP - 685

EP - 693

JO - Academic Emergency Medicine

JF - Academic Emergency Medicine

SN - 1069-6563

IS - 6

ER -